Pain management post open heart surgery?

Specialties CCU

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A very close relative had open heart surgery for an aortic valve replacement 2 days ago. She is 84 years old. She was extubated late the same day, and is now in the cardiac step down unit @ her hospital. According to her sister, she got out of bed with assistance yesterday, and spent 3 hours in a chair. Yikes! I couldn't do that. She still has bilateral chest tubes, a mediastinal tube, pacing wires, 2 IVs and a foley catheter. She said that she was in a lot of pain, but would do whatever they asked her to, so se could get well.

I did have a question. What can I expect as far as what's usually ordered for pain management for someone who is 1-2 days post-op? My experience has been in pediatric med-surg (to age 21) and NICU nursing only. The only thing my relative is receiving for pain is p.o. Percocet every 4 hours prn. She is allergic to Morphine.

She's hesitant to "bother" someone to ask for additional pain meds. She's of the old school that thinks if you ask the nursing staff for too much, they will be upset with you b/c you've "increased their work load", or are a 'high-maintenance" patient.

Is it fairly typical to use Percocet only for someone who's 24 hours post open heart surgery?

In our institution we use Tramadol as a drip for our post open heart patients. This is to eliminate the risk of bleeding with Toradol and to help decrease chances for drowsiness in patients for more chances to rehabilitate the lungs post op. We preferred it to be a drip to have a continuous dose and coverage to make up for its halflife and other pharmacokinetics. If still with pain acetaminophen IV as adjunct will be added to the regimen. But, since pain is very much relative to each person knowing that the patient has a low threshold for pain, we usually have them on Fentanyl via PCA then titrated down to the least of the patient's requirement. :)

A Tramadol gtt? BARF. What psycho MD thought up that idea? Tramadol shouldn't even be on the market IMO, let alone as the method for post open heart pain relief. A seizure is just what a post open heart patient needs. /rant

I do understand where you're coming from about tramadol however as a drip, nausea is boiled down to a minimum since its administration goes in real slow. From experience pain associated with the sternotomy is resolved by tram in 80% of our patients. Most of the pain complaints come from thr chest tubes. The tramadol drip would run for a max of 24 hrs immediate post op and shifted to orals. We make it a point that any cause of drowsiness be eliminated to facilitate lung rehab as early as possible post extubation. So there. Lol. :)

Lol. Yeah I understand the rationale. I'm just a stickler when it comes to Tramadol. I think it's highly misused by physicians. Anyway, /rant. :)

l was so glad that l was able to read other stories very similar to our own recent experiences ongoing....our dad has just had a double bypass ,and the nursing care etc. has been outstanding,which is not said very often now a days due to many many reasons... the only worry l have is the misunderstanding of the powers of paracetmol !!!! after 5 1/2 hours in surgery, ICU was fab, HDU was fab but then less than 24hrs later paracetmol appears again to take charge.after 24yrs in the nhs, even l know that pain management is the key to either a successful / poor recovery of the patient. so why does it keep getting over looked? during the last 10 days,and talking to others of a simaular position,it really is a key problem. most of the patients who have had poor pain management "appear "to develop chest infections within 72.hrs of surgery. l know there is always this risk but,if a patient is not able to do his/her breathing excerises,mobilize as soon as possible then they are not able to help inflate their lungs,or mobilize gradually,again to ward off all those post op nasties as successfully as they could do in order to promote well-being and discharge home as soon as able. l know the flip side of this is pain masking, dependancy and other pain medication related problems,but surely there must be some common ground that could be aimed for together helping the patient "get better"as we hoped? A lot of the children's services seem to have got there heads around this paracetmol

myth,so why can't the adult services do the same? has anyone got any stats. re;this matter as l'd love to read/study them?

many thanks for the other letters,support comes in many varieties.....

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